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Policy Brief HEALTH POLICY INSTITUTE Action — Innovation — Mobilization POLICY BRIEF MOVING UPSTREAM: POLICY STRATEGIES TO ADDRESS SOCIAL, ECONOMIC, AND ENVIRONMENTAL CONDITIONS THAT SHAPE HEALTH INEQUITIES BRYANT CAMERON WEBB © 2012 JOINT CENTER FOR POLITICAL AND ECONOMIC STUDIES MovingUpstream PREP.indd 1 4/2/12 11:38 AM MovingUpstream PREP.indd 2 4/2/12 11:38 AM MOVING UPSTREAM: POLICY STRATEGIES TO ADDRESS SOCIAL, ECONOMIC, AND ENVIRONMENTAL CONDITIONS THAT SHAPE HEALTH INEQUITIES BRYANT CAMERON WEBB APRIL 2012 HEALTH POLICY INSTITUTE JOINT CENTER FOR POLITICAL AND ECONOMIC STUDIES MovingUpstream PREP.indd 3 4/2/12 11:38 AM Opinions expressed in Joint Center publications are those of the authors and do not necessarily reflect the views of the staff, officers or governors of the Joint Center for Political and Economic Studies or of the organizations that support the Joint Center and its research. Joint Center for Political and Economic Studies, Washington, DC 20005 www.jointcenter.org © 2012 All rights reserved. Published 2012 Printed in the United States. MovingUpstream PREP.indd 4 4/2/12 11:38 AM TABLE OF CONTENTS Introduction .....................................................................................................................................................................................1 Part I: Economic and Social Conditions That Impact Health ..............................................................................................1 1. Child and Youth Development and Education ...................................................................................................1 1.1 Early Childhood Development ................................................................................................................2 1.2 Education ...................................................................................................................................................2 2. Economic Development ...........................................................................................................................................3 2.1 Training Incentives ....................................................................................................................................4 2.2 Entrepreneurship Training ......................................................................................................................4 2.3 Enterprise Zones ........................................................................................................................................4 2.4 Empowerment Zones and Renewal Communities ...............................................................................4 3. Poverty Reduction ......................................................................................................................................................5 3.1 Increasing Economic Resources for Those in Poverty ............................................................................5 3.2 Buffering the Negative Health Consequences of Poverty .....................................................................6 Part II: Living and Working Conditions That Impact Health ..............................................................................................7 4. Healthy Homes ...........................................................................................................................................................7 4.1 Integrated Pest Management ...................................................................................................................7 4.2 In-Home Tailored Interventions for Asthma ........................................................................................8 4.3 Smoke-Free Policies ...................................................................................................................................8 4.4 Lead Hazard Control ...............................................................................................................................9 4.5 Tenant-Based Rental Assistance Programs ............................................................................................9 5. Healthy Neighborhoods ........................................................................................................................................10 5.1 Spaces to Play and Exercise ...................................................................................................................11 5.2 Access to Healthy Foods ..........................................................................................................................11 5.3 Violence Prevention ................................................................................................................................13 Conclusion ....................................................................................................................................................................................14 MovingUpstream PREP.indd 5 4/2/12 11:38 AM MovingUpstream PREP.indd 6 4/2/12 11:38 AM FOREWORD Public health researchers and practitioners increasingly This policy brief, “Moving Upstream: Policy Strategies to recognize that social, economic, and environmental conditions Address Social, Economic, and Environmental Conditions that in communities and settings where people live, work, and play Shape Health Inequities,” identifies some of the policy strategies powerfully shape health. The fact that these kinds of conditions that are being studied and implemented in communities across are often systematically poorer in communities of color is the country. Prepared by Bryant Cameron Webb, a rising leader a major determinant of racial and ethnic health inequities. in medicine and health policy, we expect that this brief will be Majority-minority communities are more likely than majority- useful for policymakers, public health practitioners, community white communities to face environmental health risks, such as organizations, researchers, and others committed to improving those brought about by polluting industries and waste. They the health of people of color and eliminating health inequities. are less likely to have safe spaces for exercise and recreation. This analysis furthers the Joint Center’s long history of work And they often face a poorer retail food environment, with to identify solutions to some of our nation’s most pressing fewer vendors selling fresh, low-cost fruits and vegetables and policy issues, and ensure that people of color can continue to a heavier concentration of unhealthy foods such as fast foods contribute to the fullest extent to the rich social, economic, and and highly-processed, high-fat convenience products. These political life of the nation. kinds of community conditions make it difficult for people to maintain healthy behaviors and reduce risks for disease and Ralph B. Everett, Esq. illness. President and CEO The Joint Center for Political and Economic Studies While many of these problems have persisted for years, if not generations, they are not intractable. A number of promising policy strategies can help to address the heavy concentration of health risks in communities of color, while at the same time building upon community strengths to improve access to health-enhancing resources and create healthier communities. Many of these policy strategies lie outside of the healthcare arena, in sectors such as housing, transportation, land use, economic development, and education. Expanding opportunity in these sectors often can have important health benefits, and can be more cost-effective in reducing health inequities than by trying to solve these problems through the provision of health care or individual education or awareness efforts alone. MovingUpstream PREP.indd 7 4/2/12 11:38 AM MovingUpstream PREP.indd 8 4/2/12 11:38 AM INTRODUCTION PART I: ECONOMIC AND SOCIAL CONDITIONS THAT IMPACT HEALTH Many racial and ethnic minorities in the United States experience a disproportionate burden of disease when compared to their Access to economic resources, including income and wealth, white counterparts. These disparities have been consistently reflect access to material goods and services. Many longitudinal documented in a range of health conditions including asthma, studies have demonstrated that economic resources predict diabetes, hypertension, and HIV infection, as well as infant health, even after adjusting for education.3 Additionally, the mortality and deaths from coronary heart disease and stroke. existence of inequalities in income between racial and ethnic There are similar disparities in the various factors that are known groups have also been independently linked to disparate health to influence health. These “social determinants of health” include outcomes.5 social and economic factors, social support networks, physical and social environments, access to health services, and social and Just as depressed access to economic resources increases the health policies.1 Research indicates that social and economic burden of illness on individuals and groups, social disadvantage conditions are more powerful in determining who is healthy and is also correlated with worse health outcomes. The literature who is sick than access to medical care, genetic endowment, or is particularly extensive and persuasive on the impact of other factors.2 disadvantaged early childhood experiences on health. Additionally, a number of pathways link educational attainment Social, economic, and environmental conditions
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